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NBEO Part 2 > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

Drug class of metformin

A

Biguanides

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2
Q

Aparaclonidine drug class

A

Alpha-2 agonist
Weak alpha-1 agonist

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3
Q

What does 10% cocaine drops do to Horner’s pupils?

A

Dilation of the normal pupil (because lack of NE due to lesion in sympathetic fibers)

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4
Q

MOA of cocaine

A

Indirect adrenergic agonist
Block the re-uptake of NE by sympathetic nerve ends, leading to increase in sympathetic activity—> mydriasis, sweating, tachycardia

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5
Q

Side effects of topical antihistamines/mast cell stabilizers

A
  • Stinging upon installation
  • headaches
  • adverse taste
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6
Q

Drug that can cause floppy iris syndrome?

A

Flomax (tamsulosin)
* treatment for benign prostatic hyperplasia
* alpha-blocker

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7
Q

Amitriptyline
tx?
class?
MOA?
adverse effects

A

Tx: depression
Tricyclic antidepressant
Blocks reuptake of serotonin and norepinephrine

Side effects: weight gain, dry mouth, dry eyes, drowsiness, blurred vision, dizziness, HA, tachycardia, hypotension, nausea, seizures, photosensitivity

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8
Q

Cosopt

A

Timolol + dorzolamide
(Beta blocker + CAI)

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9
Q

Combigan

A

Timolol + brimonidine
(Beta blocker + alpha agonist)

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10
Q

Simbrinza

A

Brimonidine + brinzolamide
(Alpha agonist + CAI)

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11
Q

What is the generic name of Alrex?

A

loteprednol 0.2%

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12
Q

Which drug class does Besivance belong to?

A

4th generation fluoroquinolone

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13
Q

True or false
A compounding pharmacist is needed when a patient requires a medication but is allergic to one of the inactive ingredients

A

True
They can achieve the same therapeutic effect by preparing meds that includes same dosage of active ingredient without offending agent

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14
Q

Loteprednol is least likely to cause increase in IOP because?

A

It is ESTER-based
* causes less pressure elevation for given amount of anti-inflammatory effects

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15
Q

How long does it take for topical corticosteroids to increase IOP?

A

~1 month

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16
Q

Which glaucoma medication can cause black/brown pampered conjunctival deposits?

A

Epinephrine
* topical anti-glaucoma medication
* MOA: decrease IOP by increasing both uveoscleral and trabecular meshwork outflow

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17
Q

Contraindications of topical steroid use

A
  • Epithelial herpes simplex keratitis
  • Fungal infections
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18
Q

Contraindications of ORAL steroid use

A
  • Peptic ulcers
  • Osteoporosis
  • Psychosis
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19
Q

Which ophthalmic steroids have the highest risk for increasing IOP?

A
  • Durezol (difluprednate)
  • predforte
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20
Q

For chronic, mild inflammation management what kind of ophthalmic steroid should be prescribed?

A

Lotemax (loteprednol)
or
FML (fluorometholone)

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21
Q

What is the only steroid approved for treatment of allergic conjunctivitis?

A

Alrex (loteprednol 0.2%)
* safest because ESTER based
*treat vernal keratoconjunctivitis

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22
Q

Side effects of Accutane (potent anti-acne med)

A
  • dry eyes
  • transient myopic shift
  • blurred vision
  • decrease in night vision
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23
Q

Which 3 medications are typically used in HAART? (Highly active antiretroviral therapy?

A
  • protease inhibitors
  • nucleoside reverse transcriptase inhibitors
  • non-nucleoside reverse transcriptase inhibitors
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24
Q

Common side effect experienced by patient on HAART?

A

Hepatotoxicity
* drug induced liver damage

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25
Q

Topamax drug class

A

Anticonvulsant
* tx: seizures

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26
Q

Topamax is used to treat what conditions?

A

*** anticonvulsant

  • Epilepsy
  • bipolar disorder
  • migraines
  • depression
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27
Q

Side effects of Topamax?

A
  • Pupillary block
  • angle closure
  • myopic shift
  • occur ~ 2 weeks after initiation of Topamax therapy

Topamax is an anti-convulsant and nerve pain medication, used to prevent seizures

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28
Q

First line treatment for open angle glaucoma and/or ocular HTN

A

Prostaglandin analog
* lowers IOP the most compared to other classes of glaucoma meds

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29
Q

Side effects of prostaglandins

A
  • Iris color changes
  • hyperpigmentation of ocular adnexa (eyelids)
  • elongation of eyelashes
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30
Q

Non-selective beta blockers side effects

A
  • alter blood pressure and heart rate
  • contraindicated in asthma
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31
Q

Which med is used to tx cardiac arrhythmias, and can develop vortex keratopathy and anterior sub-capsular lens deposits?

A

Amiodarone

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32
Q

Steroids can induce what type of cataract?

A

Posterior subcapsular

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33
Q

Med used to treat gout and hyperuricemia

A

Allopurinol

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34
Q

Patients taking allopurinol have higher risk of developing cataracts if they are?

A

Elderly patients who take cumulative dose of greater than 400g

Or

Have been taking it for longer than 3 years

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35
Q

Side effects of tetracycline in kids

A
  • short stature
  • yellowing of teeth
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36
Q

Which med has been linked to Reye syndrome?

A

Aspirin
* Reye syndrome is swelling of liver and brain, rare, mostly in kids
* do not give aspirin to children

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37
Q

Which agent reduces the effects of warfarin?

A

Vitamin K
* warfarin (brand name: Coumadin) anticoagulant

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38
Q

MOA of Warfarin

A

Inhibits activation of clotting factors that depend on vitamin K synthesis
* anticoagulant

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39
Q

What is the mechanism of action of macrolides?

A

Binding to the 50S ribosomal subunit, inhibiting protein synthesis

This mechanism makes macrolides effective against certain bacteria.

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40
Q

Name a medication that belongs to the macrolide class.

A

Erythromycin

Erythromycin is available only in ointment form.

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41
Q

What are the benefits of erythromycin in ocular treatment?

A

Very little corneal toxicity and good lubricant properties

These properties make it suitable for ocular applications.

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42
Q

What is AzaSite®?

A

A formulation of azithromycin with high viscosity

Patients should avoid blinking for 5 seconds post-instillation for best absorption.

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43
Q

Why is AzaSite® beneficial for certain patients?

A

Decreased dosing schedule improves compliance

This makes it easier for patients to adhere to treatment.

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44
Q

What is the mechanism of action of bacitracin?

A

Inhibits the creation of polysaccharide chains, interfering with cell wall synthesis
* cell wall synthesis inhibitor

This action is specific to gram-positive bacteria.

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45
Q

What type of bacteria is bacitracin effective against?

A

Gram-positive bacteria

Bacitracin is a cell wall synthesis inhibitor

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46
Q

What enhances the effectiveness of bacitracin?

A

Pairing with polymyxin B

This combination creates a broad-spectrum antibiotic.

Bacitracin + polymyxin B + neomycin = neosporin

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47
Q

What is the commercial name for the combination of bacitracin and polymyxin B?

A

Polysporin®

This medication is used for treating various bacterial infections.

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48
Q

What form is bacitracin available in?

A

Only as an ointment

This limits its application compared to other forms.

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49
Q

What are potential adverse side effects of bacitracin?

A

Allergic reaction

Patients should be monitored for signs of allergy.

50
Q

What is the mechanism of action of fluoroquinolones?

A

Inhibit DNA gyrase
* therefore inhibiting bacterial DNA synthesis

51
Q

Name one medication that is a fluoroquinolone.

A

Besivance®
* 4th generation Fluoroquinolone
* broad spectrum

52
Q

True or false
Vancomycin is effective against MRSA infections

A

True

53
Q

What special instruction should be given to patients after instilling high viscosity fluoroquinolones?

A

Inhibit blinking for at least 5 seconds

54
Q

List two medications that are classified as fluoroquinolones.

A
  • Ciloxan®
  • Iquix®
55
Q

How do aminoglycosides decrease bacterial activity?

A

By binding to the 30S ribosomal subunit
* tobragent30 = tobramycin and gentamicin

56
Q

What is Neosporin® a combination of?

A
  • Polymyxin B
  • Neomycin
  • Bacitracin
57
Q

Which aminoglycoside has the greatest potential for causing contact dermatitis?

A

Neomycin

58
Q

Which aminoglycoside is available as both a solution and an ointment and has the least potential for causing corneal toxicity?

A

Tobramycin
(30S ribosomal subunit)

59
Q

Which aminoglycoside is available as both a solution and an ointment?

A

Gentamicin

60
Q

What is the mechanism of action of Polymyxin B?

A

Interferes with the cellular membranes of bacterial pathogens

Polymyxin B is not a stand-alone drug and is often used in combination with other drugs for enhanced efficacy.

61
Q

Is Polymyxin B effective against gram-positive or gram-negative bacteria?

A

Gram-negative bacteria

Polymyxin B is specifically effective against gram-negative bacterial pathogens.

62
Q

What is Polytrim®?

A

A combination of polymyxin B and trimethoprim

Polytrim® is known for its effectiveness against MRSA.

63
Q

What is the composition of Polysporin®?

A

Combination of polymyxin B and bacitracin

Polysporin® is used to treat various infections and is a topical antibiotic.

64
Q

What are the components of Neosporin®?

A

Combination of polymyxin B, neomycin, and bacitracin

Neosporin® is a widely used topical antibiotic ointment.

65
Q

What is the mechanism of action of sulfonamides?

A

Interfere with the synthesis of folic acid

Sulfonamides are not commonly used in eye care due to sensitivity and allergy issues.

66
Q

Why are sulfonamides not commonly used in eye care?

A

Increased patient sensitivity and allergy as well as increased resistance displayed by common bacterial pathogens

These factors contribute to their limited use in treating eye infections.

67
Q

True or False: Polymyxin B can be used as a stand-alone drug.

A

False

Polymyxin B is typically used in combination with other antibacterial agents to enhance its efficacy.

68
Q

Fill in the blank: Polytrim® is effective against _______.

A

MRSA

MRSA stands for Methicillin-resistant Staphylococcus aureus, a common and difficult-to-treat bacterial infection.

69
Q

What is a key indicator that an ocular infection is not bacterial?

A

Absence of ocular discharge

If there is no ocular discharge, chances are the culprit is not bacterial in nature.

70
Q

What does sectoral injection of the conjunctiva with a clear cornea indicate?

A

An infectious process is unlikely

If there is sectoral injection of the conjunctiva and the cornea is clear, an infectious process is unlikely.

71
Q

Which three topical medications offer the best protection against common bacteria causing ocular infections?

A
  • Gentamicin
  • Polytrim®
  • Besivance®

These three medications lead to the least antibiotic resistance in patients.

72
Q

What are the two most common bacteria that cause ocular infections?

A
  • Staphylococcus aureus
  • Staphylococcus epidermidis

Staphylococcus aureus can be associated with MRSA.

73
Q

What is the advantage of Vancomycin regarding ocular infections?

A

Excellent protection against S. aureus and S. epidermidis

Vancomycin must be compounded prior to ocular use.

74
Q

True or False: Newer antibiotics are always better than older ones.

A

False

Newer is not necessarily better.

75
Q

Fill in the blank: If there is no ocular discharge, it is likely that the infection is not _______.

A

[bacterial]

This indicates that the cause of the ocular issue may be non-bacterial.

76
Q

What is a potential complication of using topical antibiotics for ocular infections?

A

Antibiotic resistance

The three medications mentioned lead to the least antibiotic resistance in patients.

77
Q

Tx for toxoplasmosis

A

Pyrimethamine and sulfasiazine + corticosteroids
* can be self-limiting and tx is not required

78
Q

Which antibiotic when used alone has the highest risk of causing pseudomembranous colitis?

A

Clindamycin
* but if used with sulfadiazine decreased risk of developing
* if patient experiences diarrhea discontinue medication

79
Q

What unwanted side effects are associated with Pyrimethamine?

A

Thrombocytopenia, leucopenia, and folate deficiency

Pyrimethamine can lead to a diminished amount of platelets, a decreased number of white blood cells due to bone marrow suppression, and a deficiency of folate.

80
Q

Why should Pyrimethamine not be used in patients who are immunocompromised?

A

It can cause bone marrow suppression, leading to decreased white blood cell counts

This increases the risk of infections in immunocompromised patients.
* can cause leucopemia therefore pt needs to get weekly CBC
* pyrimethamine used to treat toxoplasmosis

81
Q

What should patients taking Pyrimethamine also be prescribed to prevent folate deficiency?

A

Folic acid mixed with orange juice

This is a preventative measure against the folate deficiency caused by Pyrimethamine.

82
Q

How often must patients on Pyrimethamine have their blood levels monitored?

A

Weekly

Patients must have weekly blood draws to monitor red and white blood cell levels and platelet counts.

*tx toxoplasmosis, DO NOT GIVE TO PREGNANT OR BREAST FEEDING WOMEN

83
Q

Which medication is effective against T. gondii but has significant side effects?

A

Pyrimethamine

Despite its effectiveness, Pyrimethamine’s side effects can be serious, necessitating careful monitoring.

84
Q

Fill in the blank: Pyrimethamine can lead to _______ due to its effects on bone marrow.

A

leucopenia

Leucopenia refers to a decreased number of white blood cells.

*used to treat toxoplasmosis
* pt must get weekly CBC while on medication (platelet count less than 100,000 must reduce dosage)
* do not take vitamins with folic acid

85
Q

Zymaxid
Generic name?
Drug class?
Dosage to tx corneal abrasions?

A
  • Gatifloxacin
  • Fluoroquinolone
  • Dosage to tx corneal abrasion: QID with PF AT’s q2h
86
Q

Isotrentinoin, oral contraceptives, Topamax, and diuretics can cause what type of refractive shift?

A

Myopic shift
* myopia from corneal swelling, lens swelling, acc spasm, edema of ciliary body

87
Q

Zoloft
Drug Class?
MOA?
Tx?

A
  • SSRI: selective serotonin reuptake inhibitor
  • Inhibit reuptake of serotonin, kept in synaptic cleft longer and repeatedly stimulates receptors
  • serotonin: neurotransmitter contributes to feelings of well-being and happiness

Tx: depression

88
Q

Zoloft has been FDA approved to treat what conditions?

A

Major depressive disorder
OCD
PTSD
premenstrual dysphoric disorder
Social anxiety disorder

89
Q

What is the primary difference in effectiveness between oral NSAIDs and topical NSAIDs?

A

Oral NSAIDs provide an anti-inflammatory effect while topical NSAIDs are more effective in superficial pain management

90
Q

What is Acular LS® used for?

A

Management of seasonal allergic conjunctivitis
*and for post surgical inflammation and pain

  • Acular is brand name for ketorolac
    Dosage: q.i.d.
91
Q

What is unique about Acuvail® in terms of its packaging?

A

Available in single dose preservative-free vials

Ketorolac (NSAID)
Dosage: b.i.d.

92
Q

What must be done before instilling llevro®?

A

The bottle must be shaken prior to drop instillation

Dosage: q.d.
* NSAID, used to manage post surgical CME

93
Q

What type of drug is Nevanac® and how does it work?

A

A prodrug that is converted to amfenac sodium which actively inhibits cyclooxygenase

Dosage: t.i.d.

94
Q

What is a notable characteristic of Prolensa®?

A

Possesses a lower pH which allows for potential increased retention time

Bromfenac (NSAID 4
Dosage: q.d.

95
Q

What is the dosage for Voltaren®?

A

q.i.d

96
Q

What is the dosage for Bromday®?

A

q.d.

97
Q

List some clinical uses of NSAIDs.

A
  • Pre-and post-operative inflammation
  • Management or prevention of cystoid macular edema
  • Corneal abrasions
  • Management of pingueculitis or inflamed pterygia
  • Allergic conjunctivitis
  • Aiding in the adaptation of punctal plugs
98
Q

What are the clinical uses of NSAIDs?

A

Pain management secondary to foreign body removal, pain management associated with stromal puncture, post-PKP management

PKP stands for penetrating keratoplasty, a type of corneal transplant surgery.

99
Q

What is a potential adverse side effect of NSAIDs related to the cornea?

A

Corneal toxicity and corneal melt

Corneal toxicity refers to damage to the corneal tissue, while corneal melt describes the degradation of corneal structure.

100
Q

What is one of the adverse side effects of NSAIDs regarding wound healing?

A

Delayed wound healing

101
Q

What sensations may patients experience with NSAID instillation?

A

Stinging and burning

102
Q

Fill in the blank: NSAIDs are used for pain management associated with _______.

A

[stromal puncture]

103
Q

If the daily dose of hydroxychloroquine does not exceed ____ mg, the risk for maculopathy is low

A

400 mg

104
Q

Risk of plaquenil toxicity increases when the daily dose is over ___ mg/kg over a period of ___ years

A

6.5 mg/kg
5 years

105
Q

Classic retinal findings of hydroxychloroquine maculopathy on fundus and OCT

A
  • On fundus: bulls eye maculopathy
  • On OCT: flying saucer sign
106
Q

Ritalin, Concerta and Adderall are what type of ADHD drugs?

A

Psycho-stimulants
* provide a calming effect for patients with ADHD

107
Q

True or false
Strattera is considered a non-stimulant ADHD medication.

A

TRUE
* effective as the stimulant medications (Ritalin, adderall and concerta) but lower potential for abuse

108
Q

Recommended dose of oral prednisone to pt with acute s/s of Bell’s palsy

A

60 mg per day for 5 days
Then taper by 10mg per day for the next 5 days (total treatment of 10 days)

109
Q

Recommended dose of oral prednisone to pt with acute s/s of Bell’s palsy

A

60 mg per day for 5 days
Then taper by 10mg per day for the next 5 days (total treatment of 10 days)

110
Q

Which drug class has an absolute contraindication to using 10% phenylephrine?

A

Tricyclic antidepressants (ex: amitriptyline)
* Phenylephrine adversely interacts with TCA, monoamine oxidase inhibitors and alpha blockers

111
Q

Phenylephrine adversely interacts with what drugs?

A
  • TCA (tricyclic antidepressants)
  • monoamine oxidase inhibitors
  • alpha adrenergic blockers
112
Q

What drugs can cause pseudo tumor cerebri?

A

CATS!
Contraceptives
Accutane (isotrentinoin)
Tetracyclines
Synthroid

113
Q

What is fluticasone?

A

A synthetic corticosteroid with potent anti-inflammatory action

Fluticasone is effective in controlling asthmatic complications due to inflammation.

114
Q

Why is fluticasone effective in asthma?

A

It has a potent anti-inflammatory action that helps control asthmatic complications

Inflammation is a key factor in the pathogenesis of asthma.

115
Q

What should patients using Advair® be monitored for?

A

Intraocular pressure and possible development of cataracts

Regular examinations are necessary for patients using corticosteroids.

116
Q

What is salmeterol?

A

A long-acting beta2-adrenergic agonist

Salmeterol is used for bronchodilation in asthma management.

117
Q

What receptors do beta2-adrenoceptors predominantly affect?

A

Bronchial smooth muscle

They have little association with the heart.

118
Q

What effect does salmeterol have on cyclic AMP levels?

A

It increases the levels of circulating cyclic AMP in the bloodstream

This leads to relaxation of bronchial smooth muscle.

119
Q

What is the result of increased cyclic AMP due to salmeterol?

A

Relaxation of bronchial smooth muscle and inhibition of hypersensitivity mediators

This is particularly effective in preventing bronchoconstriction.

120
Q

Which TB drug causes orange/pink tears?

A

Rifampin

121
Q

True or false
Prostaglandins for IOP treatment are contraindicated in pts with Hx of Herpes simplex infection

A

True

NBEO Part 2 (20 decks)

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